1991, 12-16 Permit App: 91008651 WoodstoveDEC -09-191 15.25 ID:DEPT OF DUILDINGS TEL NO:509-456-4707,, P01
MECHANICAL PERW APPLICATION FORM
s�I#5E0
Information Worksheet
.JOB. STREET ADD.1.3ES,S:
CITY/STATE/ZIP:-sa�-61i,,; uji4 i r�;1 /(,_;
PARCEL NUMBER:
OWNER:�u 1ir r rrte.n �'r _
PHONE NUMBER:
MAILING AODRESS:_
(Street)
(City/State)
(zip)
CONTRACTOR:
LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street)
(City/State)
(Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER
X EACH
DESCRIPTION
OF UNITS
UNIT
AMOUNT
ELECTRIC/D�yyUCTWORK (SEPARATE SYSTEMS)
x 10.00
a.. �"°''b"• � e�.fy�p^�xMa��t
x 25.00!:
-..... .. .��..
C3AS WATER HEATER
.
x 10.00
_
x 12.00
"'.Y`'.i.xc
GAS EQUIPMENT +100,060 BTU DUCTWOflK)
x 15.00 s
x 1.00
BOILERlREFRrG 1-X00%;VM%j BTU�4
x 12.00 =
x 20.00
BOrLER/REFRtQ so1�1,40nM eTU
x 25.00 =
x 35.00 =
Bat:EwRIFRIG +� �soM sru; 1.
x 60.00 «m
•�, .
12,00; =.�•
`«Y 7'k'4:" r ti .�4{;apr
Y
��', .�
ONER.3=i57bN$
x 20.00
x '
'::•xJ�,�''�`
s ". .
i
L'[�l �A �A T�1��
ER 3ii;W-:1 VIAS'
825.00
x JJ.W
All
IN Mom
X60.00a
x 10.00 �.'
_ %: '•'�:�V.vtf �.�''�1.
'
-f --11
x 1100.00
'..a. ..
.
A
'12#.l� 1 . OF ! 0000
X 50.00 =
y aq
x 10.00 =
x 10.00 .�
x 10.00
x 10.00 i
_
x 10.00 =
E <400,000 STU
x 54.00 =
r�
x100.00 =
B7Y1,Y.,.•;•
x 50.00 .
#`
x100.00 =
x 12,00 =
i
;: wz tik INW;
x 15.00
SUBTOTAL
$ �n
PLUS: PROCESSING FEE
+$ 25.00
NOTE: MINIMUM PERMIT FEE IS $35.00
EQUALS: TOTAL PERMIT
FEE DUE1=$
", -'
SIGNATUR
f
Sp16ka County
Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456--3675